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Treatment

There are several treatment options for multiple myeloma, and sometimes a combination of therapies may be used. Multiple myeloma cannot be cured, but therapies may help keep the cancer in remission.

People should get second opinions, talk through all of their options with their doctors and develop a treatment plan that best fits their needs. The treatment plan varies on how advanced the disease is, whether the person has symptoms, and on the person’s overall health status. It is important to remember that these are general guidelines and that your doctor might suggest a treatment plan that differs from what is listed below. Do not hesitate to ask questions and be an active part of your treatment planning process.

After a diagnosis of asymptomatic (smoldering myeloma) or multiple myeloma is made, treatment options can include:

Watchful waiting

Bisphosphonates

Chemotherapy

Radiation therapy

Stem cell transplant

Targeted therapy

Biological therapy

It is important to note that it is common to use more than one treatment option at a time, as many therapies work together to treat the disease.

Watchful Waiting

People with stage I or smoldering myeloma may not need treatment for the cancer right away. These people have regular checkups and can start treatment if symptoms occur. It is very important to talk to your doctor if you begin experiencing signs or symptoms of multiple myeloma, so that your doctor can determine if you need to begin treatment immediately.

Bisphosphonates

Myeloma cells can weaken and damage bones. Bisphosphonates are drugs used to treat prevent further bone damage, slow the damage process, and treat symptoms of bone damage caused by multiple myeloma. The most common bisphosphonates used in people with multiple myeloma are given through the vein, such as pamidronate (Aredia®) and zoledronic acid (Zometa®).

Chemotherapy

Chemotherapy drugs are used to kill fast-growing cancer cells. Unfortunately, they also kill fast-growing healthy cells – leading to common side effects such as hair loss and gastrointestinal problems. Chemotherapy can also affect blood counts, which can lead to anemia, infection, bruising or bleeding.

Chemotherapy drugs used commonly to treat multiple myeloma include:

Melphalan (Alkeran®)

Cyclophosphamide(Cytoxan®)

Doxorubicin (Adriamycin®)

Liposomal doxorubicin (Doxil®)

Vincristine (Oncovin®)

Etoposide (VP-16)

Radiation therapy

Radiation therapy uses high-powered x-rays to target tumors and disrupt the growth of cancer cells. It is most often used to shrink a tumor within a bone in order to relieve bone pain, or often used in combination with other therapies.

Stem cell transplant

A stem cell transplant involves the collection of healthy stem cells, the use of chemotherapy to kill cancer cells, then the reinfusion of the healthy stem cells so that new blood cells can form. There are two ways to get stem cells for people with myeloma, from their own body (autologous stem cell transplant) or a donor (allogenic stem cell transplant). An autologous stem cell transplant is considered a standard treatment for patients with multiple myeloma, while an allogeneic stem cell transplant is considered for specific patients only.

Targeted therapy

Drugs are used to block the growth of myeloma cells by blocking the action of abnormal protein that stimulates the growth of myeloma cells.

Targeted therapies are designed to interfere with proteins found in myeloma cells. These drugs include bortezomib (Velcade®), and carfilzomib (KyprolisT®). These agents are more targeted than traditional chemotherapy, but may still cause side effects that can include nausea, gastrointestinal problems, and possibly nerve damage and numbness.

Biological therapy

Biological therapy drugs work by activating the body’s immune system to fight myeloma cells. These drugs enhance the immune system cells that identify and attack cancerous cells and are taken in oral (pill) form. Examples of such biological therapies include thalidomide (Thalomid ®), lenalidomide (Revlimid ®), and pomalidomide (Pomalyst ®).

Questions to Ask Your Health Care Team:

1. Which treatment(s) do you recommend? What is the goal of the treatment?
2. When will treatment start? When will it end? How often and where will I have my treatment?
3. Do you recommend a stem cell transplant, if so, what should I do to prepare? How will I feel during and after this treatment?
4. Do I need a caregiver during and after treatment? If so, for how long?
5. What can I do to feel better during recovery?
6. What side effects should I anticipate? Can I prevent or treat any of these side effects?
7. Will there be long-lasting side effects? What can I do about them?
8. How will I know if my treatment is working?
9. How often will I need checkups? What follow up testing will I need and how often?
10. What information do you have so I can learn more about this treatment?
11. What types of resources are available to me during my treatment (i.e. social worker, nutritionist, case manager, financial resources)? Who will be a part of my healthcare team and what is the role of each member?
12. What stage is my disease? What does this mean in regards to my treatment?
13. Is my kidney function being affected?
14. How will the recommended treatment affect my life on a daily basis? Will I be able to continue with my normal activities as I do them now?
15. (If applicable) Could this treatment affect my fertility? Would you recommend I consult with a fertility specialist before beginning treatment?
16. Should I seek a second opinion prior to beginning treatment? If so, who would you recommend I see?
17. Are there clinical trials open to me? How do I find out more about these trials?

Clinical Trials

Clinical trials offer people the opportunity to benefit from new combinations of therapies while also advancing research about the disease and treatment options.

Each trial has specific guidelines and eligibility criteria, including age, exclusions based on prior treatments and stage of your disease. Talk to your doctor or nurse about participating in a clinical trial.

There are a number of clinical trials testing new drug combinations and newer therapies in people with multiple myeloma, including people who have recurrent disease. Some clinical trials test new ways to use drugs or techniques that are already approved. To find out more about clinical trials, speak with your doctor.